The power of two

Your partner can become a pillar of strength when you work together as a couple

By Barbara Boughton

There’s no doubt that the nature of your relationship with a “significant other” has a major effect on managing bipolar. Research now shows that having a supportive partner may be just as important as medication and psychotherapy in preventing relapse, according to Sagar Parikh, MD, a professor of psychiatry at the University of Toronto. Likewise, the stress of high-conflict relationships or the emotions that accompany breakup and divorce can sometimes exacerbate symptoms of the disorder, Parikh says. So what can you do to make your partner an ally in recovery?

The first step, says Parikh, is education—for both of you.

The more that both partners know about symptoms, treatments, and coping strategies, the more they can work together to address common challenges. Reading and online research, workshops presented by mental health organizations, discussions with mental health practitioners, and peer support groups are all good ways to get informed. A partner or spouse who is up to speed on what it takes to live with bipolar will find it easier to understand when you ask for support. The next step is learning to discuss matters relating to your illness openly and honestly.

For one thing, being able to share what’s going on in your life and your head provides your partner with a context for any irritability, sadness or high spirits you exhibit. For another, it gives you both a touchstone for recognizing early signs of a mood shift. Elizabeth and her husband, Rory, who have been married since August 2012, have a conversation at least once a week about any symptoms Elizabeth might be experiencing. “Regular communication is really important,” says Elizabeth, 32, of British Columbia. “We talk about what I’m feeling and things that he notices about me. Sometimes, it’s hard for me to see the forest for the trees, especially if I’m not feeling well.”

Rory’s feedback provides her with a reality check, Elizabeth says. “Last year I had a manic episode and Rory realized something was wrong when I told him: ‘I want to go on a 5K run.’ I’m a pretty sedentary person, so for me that’s out of character. It gave Rory a clue that I might be experiencing mania,” she recalls.

In most intimate relationships, it’s important to make significant others aware of red flags, according to David Miklowitz, PhD, a professor of psychiatry and director of the Child and Adolescent Mood Disorders Program at the Semel Institute for Neuroscience and Human Behavior at the University of California–Los Angeles. “People with bipolar disorder can make a list of symptoms and behaviors that they know indicate early signs of a manic or depressive episode. The partners can then refer back to these lists in order to spot early symptoms,” Miklowitz says.

Comfort levelWith education and experience, partners often become adept at spotting subtle signs, Miklowitz notes—sometimes before the person with bipolar does.

“Then the question becomes: If your partner spots early signs of mania or depression, what do you want them to do with that information?” Miklowitz says.

“Do you want them to call your doctor? Do you want them to go in with you for a therapy session, or encourage you to take your medicines? Some people like that kind of active support from their partners, and some do not.”

In some cases, Miklowitz says, intervention from a spouse can be seen as “too parental or too controlling.”

The bottom line is this: In order to tell your partner how to be helpful, you first need to know what kind of help you want. That’s highly individual, so every couple will find a different fit. After a disturbing interaction with a friend or boss, one person may simply want to vent while another seeks advice on how to resolve the situation.

Bill, 67, has never looked for a lot of hands-on involvement from his wife, Telle. The couple lives in California, and has been married for 20 years.

“The main way that Telle has supported me is through her acceptance of me—and that’s been very important to me and our relationship. She knows that I can stand on my own two feet, and she doesn’t judge me,” says Bill, a retired refrigeration pipe fitter.

What Bill appreciates are Telle’s understanding and compassion for his symptoms, her trust that he is working to get the best treatment he can, and her emotional support when he’s had to be hospitalized.

Still, Telle has occasionally taken an active role in Bill’s care. In May 2012, Bill became delusional while being assessed at a hospital for a blood clot in his lung. Telle spoke to his psychiatrist, who arranged for Bill to be admitted for psychiatric intervention.

If your partner does take an active role, Miklowitz says, it’s important to understand that the person will probably make mistakes.

“It’s crucial to give your partner some leeway, especially in the beginning of a relationship, when they’re just getting to know you and the effects of your illness. They’re not trying to control you. They’re just trying to help, and they don’t always know how to best do that,” he says.

Talking pointsOnce you are clear in your own mind about what role you’d like your partner to take, Miklowitz notes, it’s crucial to be direct in expressing your wishes—and also to listen to what your partner has to say.

Miklowitz recommends asking “clarifying questions” to make sure you understand your partner’s point of view. To doublecheck that you’re interpreting correctly, practice repeating back what the other person said—a technique known as reflective listening or mirroring.... [end of excerpt]